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Abstract
Hypopituitarism refers to deficiency of one or more hormones produced by the anterior
pituitary or released from the posterior pituitary. Hypopituitarism is associated
with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic
hormone (ACTH) deficiency. Onset can be acute or insidious, and the most common cause
in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy.
Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating
hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone,
and antidiuretic hormone deficiency dynamic stimulation tests are usually needed.
Repeated pituitary function assessment at regular intervals is needed for diagnosis
of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment
exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and
desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications
in replacement treatment are needed during the transition from paediatric to adult
endocrine care, and during pregnancy.